|
BF OFFSET HUM HEAD 18*56
|
Facility
|
IP
|
$11,218.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.62 |
| Max. Negotiated Rate |
$10,769.99 |
| Rate for Payer: Aetna Commercial |
$8,638.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,750.62
|
| Rate for Payer: Cash Price |
$5,609.37
|
| Rate for Payer: Cigna Commercial |
$9,311.55
|
| Rate for Payer: First Health Commercial |
$10,657.80
|
| Rate for Payer: Humana Commercial |
$9,535.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,199.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,279.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,872.49
|
| Rate for Payer: Ohio Health Group HMO |
$8,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,974.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,760.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,740.93
|
| Rate for Payer: PHCS Commercial |
$10,769.99
|
| Rate for Payer: United Healthcare All Payer |
$9,872.49
|
|
|
BF OFFSET HUM HEAD 19*46
|
Facility
|
OP
|
$11,218.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.62 |
| Max. Negotiated Rate |
$10,769.99 |
| Rate for Payer: Aetna Commercial |
$8,638.43
|
| Rate for Payer: Anthem Medicaid |
$3,858.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,750.62
|
| Rate for Payer: Cash Price |
$5,609.37
|
| Rate for Payer: Cigna Commercial |
$9,311.55
|
| Rate for Payer: First Health Commercial |
$10,657.80
|
| Rate for Payer: Humana Commercial |
$9,535.93
|
| Rate for Payer: Humana KY Medicaid |
$3,858.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,897.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,199.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,279.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,935.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,872.49
|
| Rate for Payer: Ohio Health Group HMO |
$8,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,974.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,760.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,740.93
|
| Rate for Payer: PHCS Commercial |
$10,769.99
|
| Rate for Payer: United Healthcare All Payer |
$9,872.49
|
|
|
BF OFFSET HUM HEAD 19*46
|
Facility
|
IP
|
$11,218.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.62 |
| Max. Negotiated Rate |
$10,769.99 |
| Rate for Payer: Aetna Commercial |
$8,638.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,750.62
|
| Rate for Payer: Cash Price |
$5,609.37
|
| Rate for Payer: Cigna Commercial |
$9,311.55
|
| Rate for Payer: First Health Commercial |
$10,657.80
|
| Rate for Payer: Humana Commercial |
$9,535.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,199.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,279.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,872.49
|
| Rate for Payer: Ohio Health Group HMO |
$8,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,974.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,760.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,740.93
|
| Rate for Payer: PHCS Commercial |
$10,769.99
|
| Rate for Payer: United Healthcare All Payer |
$9,872.49
|
|
|
BF OFFSET HUM HEAD 19*52
|
Facility
|
IP
|
$9,241.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,772.45 |
| Max. Negotiated Rate |
$8,871.84 |
| Rate for Payer: Aetna Commercial |
$7,115.95
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.37
|
| Rate for Payer: Cash Price |
$4,620.75
|
| Rate for Payer: Cigna Commercial |
$7,670.44
|
| Rate for Payer: First Health Commercial |
$8,779.42
|
| Rate for Payer: Humana Commercial |
$7,855.27
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,578.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.45
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,393.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,040.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,376.64
|
| Rate for Payer: PHCS Commercial |
$8,871.84
|
| Rate for Payer: United Healthcare All Payer |
$8,132.52
|
|
|
BF OFFSET HUM HEAD 19*52
|
Facility
|
OP
|
$9,241.50
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,772.45 |
| Max. Negotiated Rate |
$8,871.84 |
| Rate for Payer: Aetna Commercial |
$7,115.95
|
| Rate for Payer: Anthem Medicaid |
$3,178.15
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$7,208.37
|
| Rate for Payer: Cash Price |
$4,620.75
|
| Rate for Payer: Cigna Commercial |
$7,670.44
|
| Rate for Payer: First Health Commercial |
$8,779.42
|
| Rate for Payer: Humana Commercial |
$7,855.27
|
| Rate for Payer: Humana KY Medicaid |
$3,178.15
|
| Rate for Payer: Kentucky WC Medicaid |
$3,210.50
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$7,578.03
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$6,820.23
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$2,772.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,241.92
|
| Rate for Payer: Ohio Health Choice Commercial |
$8,132.52
|
| Rate for Payer: Ohio Health Group HMO |
$6,931.12
|
| Rate for Payer: Ohio Health Group PPO Differential |
$7,393.20
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$8,040.10
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$6,376.64
|
| Rate for Payer: PHCS Commercial |
$8,871.84
|
| Rate for Payer: United Healthcare All Payer |
$8,132.52
|
|
|
BF OFFSET HUM HEAD 19*56
|
Facility
|
IP
|
$11,218.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.62 |
| Max. Negotiated Rate |
$10,769.99 |
| Rate for Payer: Aetna Commercial |
$8,638.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,750.62
|
| Rate for Payer: Cash Price |
$5,609.37
|
| Rate for Payer: Cigna Commercial |
$9,311.55
|
| Rate for Payer: First Health Commercial |
$10,657.80
|
| Rate for Payer: Humana Commercial |
$9,535.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,199.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,279.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,872.49
|
| Rate for Payer: Ohio Health Group HMO |
$8,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,974.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,760.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,740.93
|
| Rate for Payer: PHCS Commercial |
$10,769.99
|
| Rate for Payer: United Healthcare All Payer |
$9,872.49
|
|
|
BF OFFSET HUM HEAD 19*56
|
Facility
|
OP
|
$11,218.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.62 |
| Max. Negotiated Rate |
$10,769.99 |
| Rate for Payer: Aetna Commercial |
$8,638.43
|
| Rate for Payer: Anthem Medicaid |
$3,858.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,750.62
|
| Rate for Payer: Cash Price |
$5,609.37
|
| Rate for Payer: Cigna Commercial |
$9,311.55
|
| Rate for Payer: First Health Commercial |
$10,657.80
|
| Rate for Payer: Humana Commercial |
$9,535.93
|
| Rate for Payer: Humana KY Medicaid |
$3,858.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,897.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,199.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,279.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,935.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,872.49
|
| Rate for Payer: Ohio Health Group HMO |
$8,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,974.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,760.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,740.93
|
| Rate for Payer: PHCS Commercial |
$10,769.99
|
| Rate for Payer: United Healthcare All Payer |
$9,872.49
|
|
|
BF OFFSET HUM HEAD 21*40
|
Facility
|
OP
|
$11,218.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.62 |
| Max. Negotiated Rate |
$10,769.99 |
| Rate for Payer: Aetna Commercial |
$8,638.43
|
| Rate for Payer: Anthem Medicaid |
$3,858.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,750.62
|
| Rate for Payer: Cash Price |
$5,609.37
|
| Rate for Payer: Cigna Commercial |
$9,311.55
|
| Rate for Payer: First Health Commercial |
$10,657.80
|
| Rate for Payer: Humana Commercial |
$9,535.93
|
| Rate for Payer: Humana KY Medicaid |
$3,858.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,897.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,199.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,279.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,935.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,872.49
|
| Rate for Payer: Ohio Health Group HMO |
$8,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,974.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,760.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,740.93
|
| Rate for Payer: PHCS Commercial |
$10,769.99
|
| Rate for Payer: United Healthcare All Payer |
$9,872.49
|
|
|
BF OFFSET HUM HEAD 21*40
|
Facility
|
IP
|
$11,218.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.62 |
| Max. Negotiated Rate |
$10,769.99 |
| Rate for Payer: Aetna Commercial |
$8,638.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,750.62
|
| Rate for Payer: Cash Price |
$5,609.37
|
| Rate for Payer: Cigna Commercial |
$9,311.55
|
| Rate for Payer: First Health Commercial |
$10,657.80
|
| Rate for Payer: Humana Commercial |
$9,535.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,199.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,279.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,872.49
|
| Rate for Payer: Ohio Health Group HMO |
$8,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,974.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,760.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,740.93
|
| Rate for Payer: PHCS Commercial |
$10,769.99
|
| Rate for Payer: United Healthcare All Payer |
$9,872.49
|
|
|
BF OFFSET HUM HEAD 21*46
|
Facility
|
IP
|
$11,218.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.62 |
| Max. Negotiated Rate |
$10,769.99 |
| Rate for Payer: Aetna Commercial |
$8,638.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,750.62
|
| Rate for Payer: Cash Price |
$5,609.37
|
| Rate for Payer: Cigna Commercial |
$9,311.55
|
| Rate for Payer: First Health Commercial |
$10,657.80
|
| Rate for Payer: Humana Commercial |
$9,535.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,199.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,279.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,872.49
|
| Rate for Payer: Ohio Health Group HMO |
$8,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,974.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,760.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,740.93
|
| Rate for Payer: PHCS Commercial |
$10,769.99
|
| Rate for Payer: United Healthcare All Payer |
$9,872.49
|
|
|
BF OFFSET HUM HEAD 21*46
|
Facility
|
OP
|
$11,218.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.62 |
| Max. Negotiated Rate |
$10,769.99 |
| Rate for Payer: Aetna Commercial |
$8,638.43
|
| Rate for Payer: Anthem Medicaid |
$3,858.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,750.62
|
| Rate for Payer: Cash Price |
$5,609.37
|
| Rate for Payer: Cigna Commercial |
$9,311.55
|
| Rate for Payer: First Health Commercial |
$10,657.80
|
| Rate for Payer: Humana Commercial |
$9,535.93
|
| Rate for Payer: Humana KY Medicaid |
$3,858.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,897.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,199.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,279.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,935.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,872.49
|
| Rate for Payer: Ohio Health Group HMO |
$8,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,974.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,760.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,740.93
|
| Rate for Payer: PHCS Commercial |
$10,769.99
|
| Rate for Payer: United Healthcare All Payer |
$9,872.49
|
|
|
BF OFFSET HUM HEAD 21*56
|
Facility
|
IP
|
$11,218.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.62 |
| Max. Negotiated Rate |
$10,769.99 |
| Rate for Payer: Aetna Commercial |
$8,638.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,750.62
|
| Rate for Payer: Cash Price |
$5,609.37
|
| Rate for Payer: Cigna Commercial |
$9,311.55
|
| Rate for Payer: First Health Commercial |
$10,657.80
|
| Rate for Payer: Humana Commercial |
$9,535.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,199.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,279.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,872.49
|
| Rate for Payer: Ohio Health Group HMO |
$8,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,974.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,760.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,740.93
|
| Rate for Payer: PHCS Commercial |
$10,769.99
|
| Rate for Payer: United Healthcare All Payer |
$9,872.49
|
|
|
BF OFFSET HUM HEAD 21*56
|
Facility
|
OP
|
$11,218.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.62 |
| Max. Negotiated Rate |
$10,769.99 |
| Rate for Payer: Aetna Commercial |
$8,638.43
|
| Rate for Payer: Anthem Medicaid |
$3,858.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,750.62
|
| Rate for Payer: Cash Price |
$5,609.37
|
| Rate for Payer: Cigna Commercial |
$9,311.55
|
| Rate for Payer: First Health Commercial |
$10,657.80
|
| Rate for Payer: Humana Commercial |
$9,535.93
|
| Rate for Payer: Humana KY Medicaid |
$3,858.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,897.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,199.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,279.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,935.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,872.49
|
| Rate for Payer: Ohio Health Group HMO |
$8,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,974.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,760.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,740.93
|
| Rate for Payer: PHCS Commercial |
$10,769.99
|
| Rate for Payer: United Healthcare All Payer |
$9,872.49
|
|
|
BF OFFSET HUM HEAD 23*52
|
Facility
|
IP
|
$11,218.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.62 |
| Max. Negotiated Rate |
$10,769.99 |
| Rate for Payer: Aetna Commercial |
$8,638.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,750.62
|
| Rate for Payer: Cash Price |
$5,609.37
|
| Rate for Payer: Cigna Commercial |
$9,311.55
|
| Rate for Payer: First Health Commercial |
$10,657.80
|
| Rate for Payer: Humana Commercial |
$9,535.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,199.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,279.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,872.49
|
| Rate for Payer: Ohio Health Group HMO |
$8,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,974.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,760.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,740.93
|
| Rate for Payer: PHCS Commercial |
$10,769.99
|
| Rate for Payer: United Healthcare All Payer |
$9,872.49
|
|
|
BF OFFSET HUM HEAD 23*52
|
Facility
|
OP
|
$11,218.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.62 |
| Max. Negotiated Rate |
$10,769.99 |
| Rate for Payer: Aetna Commercial |
$8,638.43
|
| Rate for Payer: Anthem Medicaid |
$3,858.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,750.62
|
| Rate for Payer: Cash Price |
$5,609.37
|
| Rate for Payer: Cigna Commercial |
$9,311.55
|
| Rate for Payer: First Health Commercial |
$10,657.80
|
| Rate for Payer: Humana Commercial |
$9,535.93
|
| Rate for Payer: Humana KY Medicaid |
$3,858.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,897.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,199.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,279.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,935.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,872.49
|
| Rate for Payer: Ohio Health Group HMO |
$8,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,974.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,760.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,740.93
|
| Rate for Payer: PHCS Commercial |
$10,769.99
|
| Rate for Payer: United Healthcare All Payer |
$9,872.49
|
|
|
BF OFFSET HUM HEAD 23*56
|
Facility
|
OP
|
$11,218.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.62 |
| Max. Negotiated Rate |
$10,769.99 |
| Rate for Payer: Aetna Commercial |
$8,638.43
|
| Rate for Payer: Anthem Medicaid |
$3,858.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,750.62
|
| Rate for Payer: Cash Price |
$5,609.37
|
| Rate for Payer: Cigna Commercial |
$9,311.55
|
| Rate for Payer: First Health Commercial |
$10,657.80
|
| Rate for Payer: Humana Commercial |
$9,535.93
|
| Rate for Payer: Humana KY Medicaid |
$3,858.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,897.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,199.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,279.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,935.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,872.49
|
| Rate for Payer: Ohio Health Group HMO |
$8,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,974.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,760.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,740.93
|
| Rate for Payer: PHCS Commercial |
$10,769.99
|
| Rate for Payer: United Healthcare All Payer |
$9,872.49
|
|
|
BF OFFSET HUM HEAD 23*56
|
Facility
|
IP
|
$11,218.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.62 |
| Max. Negotiated Rate |
$10,769.99 |
| Rate for Payer: Aetna Commercial |
$8,638.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,750.62
|
| Rate for Payer: Cash Price |
$5,609.37
|
| Rate for Payer: Cigna Commercial |
$9,311.55
|
| Rate for Payer: First Health Commercial |
$10,657.80
|
| Rate for Payer: Humana Commercial |
$9,535.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,199.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,279.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,872.49
|
| Rate for Payer: Ohio Health Group HMO |
$8,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,974.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,760.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,740.93
|
| Rate for Payer: PHCS Commercial |
$10,769.99
|
| Rate for Payer: United Healthcare All Payer |
$9,872.49
|
|
|
BF OFFSET HUM HEAD 24*40
|
Facility
|
IP
|
$11,218.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.62 |
| Max. Negotiated Rate |
$10,769.99 |
| Rate for Payer: Aetna Commercial |
$8,638.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,750.62
|
| Rate for Payer: Cash Price |
$5,609.37
|
| Rate for Payer: Cigna Commercial |
$9,311.55
|
| Rate for Payer: First Health Commercial |
$10,657.80
|
| Rate for Payer: Humana Commercial |
$9,535.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,199.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,279.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,872.49
|
| Rate for Payer: Ohio Health Group HMO |
$8,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,974.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,760.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,740.93
|
| Rate for Payer: PHCS Commercial |
$10,769.99
|
| Rate for Payer: United Healthcare All Payer |
$9,872.49
|
|
|
BF OFFSET HUM HEAD 24*40
|
Facility
|
OP
|
$11,218.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.62 |
| Max. Negotiated Rate |
$10,769.99 |
| Rate for Payer: Aetna Commercial |
$8,638.43
|
| Rate for Payer: Anthem Medicaid |
$3,858.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,750.62
|
| Rate for Payer: Cash Price |
$5,609.37
|
| Rate for Payer: Cigna Commercial |
$9,311.55
|
| Rate for Payer: First Health Commercial |
$10,657.80
|
| Rate for Payer: Humana Commercial |
$9,535.93
|
| Rate for Payer: Humana KY Medicaid |
$3,858.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,897.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,199.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,279.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,935.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,872.49
|
| Rate for Payer: Ohio Health Group HMO |
$8,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,974.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,760.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,740.93
|
| Rate for Payer: PHCS Commercial |
$10,769.99
|
| Rate for Payer: United Healthcare All Payer |
$9,872.49
|
|
|
BF OFFSET HUM HEAD 24*46
|
Facility
|
IP
|
$11,218.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.62 |
| Max. Negotiated Rate |
$10,769.99 |
| Rate for Payer: Aetna Commercial |
$8,638.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,750.62
|
| Rate for Payer: Cash Price |
$5,609.37
|
| Rate for Payer: Cigna Commercial |
$9,311.55
|
| Rate for Payer: First Health Commercial |
$10,657.80
|
| Rate for Payer: Humana Commercial |
$9,535.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,199.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,279.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,872.49
|
| Rate for Payer: Ohio Health Group HMO |
$8,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,974.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,760.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,740.93
|
| Rate for Payer: PHCS Commercial |
$10,769.99
|
| Rate for Payer: United Healthcare All Payer |
$9,872.49
|
|
|
BF OFFSET HUM HEAD 24*46
|
Facility
|
OP
|
$11,218.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.62 |
| Max. Negotiated Rate |
$10,769.99 |
| Rate for Payer: Aetna Commercial |
$8,638.43
|
| Rate for Payer: Anthem Medicaid |
$3,858.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,750.62
|
| Rate for Payer: Cash Price |
$5,609.37
|
| Rate for Payer: Cigna Commercial |
$9,311.55
|
| Rate for Payer: First Health Commercial |
$10,657.80
|
| Rate for Payer: Humana Commercial |
$9,535.93
|
| Rate for Payer: Humana KY Medicaid |
$3,858.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,897.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,199.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,279.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,935.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,872.49
|
| Rate for Payer: Ohio Health Group HMO |
$8,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,974.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,760.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,740.93
|
| Rate for Payer: PHCS Commercial |
$10,769.99
|
| Rate for Payer: United Healthcare All Payer |
$9,872.49
|
|
|
BF OFFSET HUM HEAD 24*52
|
Facility
|
IP
|
$11,218.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.62 |
| Max. Negotiated Rate |
$10,769.99 |
| Rate for Payer: Aetna Commercial |
$8,638.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,750.62
|
| Rate for Payer: Cash Price |
$5,609.37
|
| Rate for Payer: Cigna Commercial |
$9,311.55
|
| Rate for Payer: First Health Commercial |
$10,657.80
|
| Rate for Payer: Humana Commercial |
$9,535.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,199.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,279.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,872.49
|
| Rate for Payer: Ohio Health Group HMO |
$8,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,974.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,760.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,740.93
|
| Rate for Payer: PHCS Commercial |
$10,769.99
|
| Rate for Payer: United Healthcare All Payer |
$9,872.49
|
|
|
BF OFFSET HUM HEAD 24*52
|
Facility
|
OP
|
$11,218.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.62 |
| Max. Negotiated Rate |
$10,769.99 |
| Rate for Payer: Aetna Commercial |
$8,638.43
|
| Rate for Payer: Anthem Medicaid |
$3,858.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,750.62
|
| Rate for Payer: Cash Price |
$5,609.37
|
| Rate for Payer: Cigna Commercial |
$9,311.55
|
| Rate for Payer: First Health Commercial |
$10,657.80
|
| Rate for Payer: Humana Commercial |
$9,535.93
|
| Rate for Payer: Humana KY Medicaid |
$3,858.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,897.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,199.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,279.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,935.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,872.49
|
| Rate for Payer: Ohio Health Group HMO |
$8,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,974.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,760.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,740.93
|
| Rate for Payer: PHCS Commercial |
$10,769.99
|
| Rate for Payer: United Healthcare All Payer |
$9,872.49
|
|
|
BF OFFSET HUM HEAD 24*56
|
Facility
|
IP
|
$11,218.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.62 |
| Max. Negotiated Rate |
$10,769.99 |
| Rate for Payer: Aetna Commercial |
$8,638.43
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,750.62
|
| Rate for Payer: Cash Price |
$5,609.37
|
| Rate for Payer: Cigna Commercial |
$9,311.55
|
| Rate for Payer: First Health Commercial |
$10,657.80
|
| Rate for Payer: Humana Commercial |
$9,535.93
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,199.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,279.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.62
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,872.49
|
| Rate for Payer: Ohio Health Group HMO |
$8,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,974.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,760.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,740.93
|
| Rate for Payer: PHCS Commercial |
$10,769.99
|
| Rate for Payer: United Healthcare All Payer |
$9,872.49
|
|
|
BF OFFSET HUM HEAD 24*56
|
Facility
|
OP
|
$11,218.74
|
|
|
Service Code
|
HCPCS C1776
|
| Hospital Charge Code |
27000011
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,365.62 |
| Max. Negotiated Rate |
$10,769.99 |
| Rate for Payer: Aetna Commercial |
$8,638.43
|
| Rate for Payer: Anthem Medicaid |
$3,858.12
|
| Rate for Payer: Anthem POS/PPO/Traditional |
$8,750.62
|
| Rate for Payer: Cash Price |
$5,609.37
|
| Rate for Payer: Cigna Commercial |
$9,311.55
|
| Rate for Payer: First Health Commercial |
$10,657.80
|
| Rate for Payer: Humana Commercial |
$9,535.93
|
| Rate for Payer: Humana KY Medicaid |
$3,858.12
|
| Rate for Payer: Kentucky WC Medicaid |
$3,897.39
|
| Rate for Payer: Medical Mutual Of Ohio HMO |
$9,199.37
|
| Rate for Payer: Medical Mutual Of Ohio POS/PPO/Traditional |
$8,279.43
|
| Rate for Payer: Molina Healthcare Benefit Exchange |
$3,365.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,935.53
|
| Rate for Payer: Ohio Health Choice Commercial |
$9,872.49
|
| Rate for Payer: Ohio Health Group HMO |
$8,414.06
|
| Rate for Payer: Ohio Health Group PPO Differential |
$8,974.99
|
| Rate for Payer: Ohio Health Group PPO No Differential |
$9,760.30
|
| Rate for Payer: Ohio Health Group PPO SOMC Employees |
$7,740.93
|
| Rate for Payer: PHCS Commercial |
$10,769.99
|
| Rate for Payer: United Healthcare All Payer |
$9,872.49
|
|
